Emergency therapy management in organophosphate intoxication

Introduction: Organophosphate insecticide was first described by Du Bois in 1948. Organophosphates irreversibly, carbamates reversibly binding to acetylcholinesterase, they form the clinical presendation by causing the cumulation of acetylcholin which is vital neurotransmitter in both Centrale Nerve System and Otonomic Nerve System in cholinergic sinapses.
Case Report: 23 years old female patient, when brought to the emergency room, has taken a half tea bottle Dicklorvos insecticide containing one hour before with oral route. She had no complaint, exit of stomach ache and nausea. She had undergo¬ne early gastrointesthinal decontamination. She was evaluated by us because of she has been confusion, sweating and flushing. Atropin and pralidoxime management was started ourself. We have not sufficient dose of pralidoxime there fore it was started in a very low dose than offered in the literature.
Conclusion: Organophosphate intoxications are life treatening events. We came to a conclusion that even early gastrointesthinal decontamination and single dose 200mg pralidoxime + 1 mg atropine IV manegement could be useful. Organophosphates in toxication are events treating of life.

Organofosfat intoksikasyonunda acil tedavi yaklaþýmý

Giriþ: Organofosfat intoksikasyonu ilk kez Du Bois tarafýndan 1948 de tanýmlanmýþtýr. Organofosfatla rirreversibl, karbamatlar reversibl olarak asetilkolinesteraza baðlanarak hem otonom hem santral sinir sistemi için hayati bir nörotransmitter olan asetilkolinin kolinerjik sinapslarda birikimine neden olarak klinik tabloyu oluþturur.
Olgu sunumu: 23 Yaþýnda kadýn hasta, acile getirildiðinde 1/2 çay bardaðý, Dichlorvos (2,2- dichlorovinily dimethyl phosphate) içeren ins etkisi disuisid amacýyla bir saat önce oral olarak almýþtý. Karýn aðrýsý, bulantý dýþýnda þikayeti yoktu. Erken gastrointestinal dekontaminasyon yapýlmýþtý. Þuur bulanýklýðý, terleme, flushing olmasý nedeniyle tarafýmýzdan deðerlendirildi. Atropin + pralidoksim tedavisi baþlandý. Elimizde yeterli doz pralidoksim olmadýðýndan literatürde önerilenden çok daha düþük dozdan verildi.
Sonuç: Organofosfat zehirlenmeleri hayatý tehdit eden vakalardýr. Erken gastrointestinal dekontamiýýasyona ilaveten tek doz 200mg pralidoksim + Inýg atropin IV tedavisinin dahi faydalý olabileceði kanaatine vardýk.